Annual healthcare spending in the United States is estimated at about $3 trillion, and is projected to grow to over $4.5 trillion by 2020. The healthcare industry impacts every American, involves serious amounts of money, and has an expenditure growth rate that may well be unsustainable.

Yet, in reviewing how U.S. authorities apply antitrust law to the markets for healthcare provider services, it becomes apparent that the agencies do not readily incorporate the policy goals of healthcare reform legislation such as The Affordable Care Act into their analysis and are instead assuming that the industry today still must fit into the boxes of traditional analysis. But incentives and practices have changed the delivery of healthcare services. The antitrust enforcement agencies and courts need to account for these incentives and look at the realities of the delivery of medical services today. They need to integrate the antitrust analysis that has served us so well with the realities driving the delivery of healthcare going forward.

The thesis of the analysis here is that the antitrust review process should not stop once there is a determination that a provider merger is likely to substantially lessen competition in a narrow market for the specific provider services in question. That analysis needs to move on from the narrow relevant market used to make the initial prediction of whether there is likely to be an adverse effect from a merger to consider more broadly whether there is sufficient evidence presented that such a loss of competition in one relevant product market is counterbalanced, or outweighed, by projected cost savings in the broader market for healthcare provider services (e.g., a hypothesized increase in the cost of primary care physician services that is compared to a hypothesized decrease in hospital admissions and the costs thereof).

The Affordable Care Act is expected to accelerate the need for additional medical care. Increased insurance coverage increases demand, and Obamacare alone is projected to require about 16,000 to 17,000 more physicians than would have been required without it.

These reforms are worthwhile, but they are really minor in comparison with the far more consequential provisions in the legislation related to the payment of physicians under Medicare. Unfortunately, many in the GOP seem completely unaware of how these provisions will work.

The heart of the bill is a new, two-tiered indexing system for physician fees. Physicians who agree to participate in Medicare Accountable Care Organizations (ACOs) — or in similar structures established by the Medicare bureaucracy — will receive a permanent 0.75 percent increase in their fees each year. Physicians that don’t join an ACO will be placed into a new Merit-Based Incentive Payment System, or MIPS. Under MIPS, the Medicare bureaucracy will assess the “quality” of a physician’s services to patients and reward or penalize them accordingly. On average, physicians in MIPS will receive a payment increase of 0.25 percent every year — far below the annual payment increase for physicians in ACOs.

The actuaries who assess Medicare finances for the administration have looked at these provisions and come to the perfectly rational conclusion that physicians will have little choice but to join an ACO to get an extra 0.5-percentage-point bump in their payments every year. By 2019, the actuaries assume that 60 percent of all physicians taking care of Medicare beneficiaries will be part of an ACO, up from 25 percent today. By 2038, they assume that 100 percent of physicians participating in Medicare will be a part of an ACO or a similar structure invented by the Medicare bureaucracy.

Former Speaker of the U.S. Representatives Newt Gingrich said something last week that many feared, but few have been willing to admit: Republicans in Congress have no intention of repealing and replacing Obamacare with patient-centered health reform.

Faced with an interviewer who seemed to believe opposition to Obamacare is actually opposition to Barack Obama, and who suggested that after this president leaves office, opposition will soften, Mr. Gingrich accused his former colleagues of misrepresenting their commitment.

Now that we are in the twilight of the Obama presidency, and Republicans have majorities in both chambers of Congress, they should be able to put such charges to rest. Unfortunately, last week’s overwhelming bipartisan support in the House of Representatives for a deal to lock in Obamacare’s way of paying doctors sends a terrible signal.

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The Department of Health and Human Services (HHS) recently announced it will expand Value Based Payment (VBP) programs that currently account for 20 percent of Medicare payments to 30 percent by 2016 and 50 percent by 2018. While VBP is supposed to improve quality and lower costs by paying for the value and/or quality of services, rather than the volume of services, multiple studies, including some by HHS, show that VBP programs have not worked. In practice they place tremendous burdens on physicians and distort the physician-patient relationship. This flawed experiment will impact all Americans since Medicare is a benchmark for all U.S. health insurance.

David A. Hyman is the H. Ross & Helen Workman Chair in Law and director of the Epstein Program in Health Law and Policy at the University of Illinois Urbana-Champaign, as well as an adjunct scholar at the Cato Institute. Earlier this month, Hyman gave the following erudite presentation on the implementation of the Patient Protection and Affordable Care Act – which he calls PPACA, not “ObamaCare” or “the Affordable Care Act” – at a faculty seminar hosted by the University of Chicago’s MacLean Center for Clinical Medical Ethics.